My first set of MRI's was done on an "open unit," which is simply a "big magnetic ring" that you pass through for exam. A "closed unit" is the kind of machine that is totally enclosed...like a big tube (the ones that give people 'claustrophobia'). These have a much stronger magnetic field and yield better images; whereas, the "open units" can supposedly "miss" alot of neurological findings, as it's just not powerful enough to record them. As I said, my MRI's were done on an "open unit" machine. They were negative/clear, with only a "suspcicious spot" on my C-spine. I have read numerous articles and have had doctors and people who work in diagnostics to confirm this. They have just recently come out with the 3Tesla, which is supposed to be the strongest yet. When I see my new Rheumatologist next week, I'm going to ask if I can have them repeated at our local hospital, as I've already checked and they DO have this new 3Tesla machine. Maybe they missed something in the first set, because that machine wasn't strong enough to pick anything up. Just something I'm pondering. Any thoughts?? Thanks! ;)
An open MRI is generally a .7 Tesla, which is a measurement of the magnetic strength. I actually had an MRI done in one that was a .3 T, and the pictures were really poor quality.
Most of the regular closed MRIs are 1.5 T, which shows things more clearly than the open machine.
I've had an MRI of my thoracic spine done on a 3 Tesla machine, and the pictures were so much clearer than my previous 1.5 T MRIs, that it was pretty amazing. It gave a clear picture of some damage that an old injury caused to my vertabra that had been missed before.
If I were you, I would request that your MRIs be repeated on a 3 Tesla machine. How long ago were your last MRIs? Sometimes doctors or insurance companies are reluctant to repeat MRIs very often.
I'm looking forward to having my MRIs repeated on a 3T in the spring, the soonest my MS neurologist would consider, since my last brain MRI was in June of last year.
Hope you can get the repeat done on a 3T...it would show so much better... I myself have had a few MRI on 1.5T... it shows lesions...20 approx...but not enough or in the area?? for a DX...so I'm hoping my next one will be on a 3T... Let us know how it goes
I had my first on a closed 1.5 showed 2 small lesion, 6 mo later had repeat on an open .3
machine and it was normal. So I have gone completly backwards lokking for a dx. I will have another MRI done this march. My neuro told me to have it in a closed machine. I do not have access to a 3T machine but I am very interested in seeing what the 1.5 shows.
Lulu (LGK54) recently posted in this forum and (I think) in her journal about her experience with a 7T machine being used experimentally. It makes for good reading.
Mine done in January was on a 1.5T closed unit, and the report noted several hyperintensities, but was very nonspecific about what they might be. I'm trying to get in to the same center of which Lulu's doctor is a part; my 1st and so far only neuro has demonstrated little proficiency and less concern, in my humble opinion, and I'm out of sick leave.
From what I've read, there's actually such a thing as a 12T machine, though how safe that might be I don't know. That's a pretty powerful magnet!
However, there's more to the MRI process than magnet strength. If MS is a possibility, then the MRI protocol for MS should be used. This is a set of instructions that determines the thickness of the 'slices' as each shot is done, and also descibes all the angles needed. The thinner the slices, the greater the likelihood of picking up lesions, particularly small ones. I don't begin to understand the technology (don't even try), so defer to Quix totally on this, and suggest that anyone wanting a better description of this protocol to check the Health Pages.
Limbolanders with clear MRIs might want to verify the technique used for their imaging. This info will be listed on the radiology report, and often next to each image as well. If you can't find it, or like me have no clue as to what it all means, a call to the imaging center should help you learn whether the MS protocol was followed.
Thanks to all who posted. Fluffysmom...I had my MRI's 2 years ago, and I'm on a different insurance plan now, so I'm sure I can have one...just has to be pre-authorized. I'm going to ask my new Rheumatologist about it next week, and see if she will prescribe an MRI-with MS Protocol, at our local hospital's 3T MRI machine (closed). I'm anxious to see if anything will show up...as my symptoms are really flaring now.
Well, I just got through calling the place that did my MRI's 2 years ago, and found out that their "open unit" machine is actually a .3Telsa....NOT EVEN A .7!! So, I'm definitely requesting to have them repeated next week!! Just thought I'd let you guys know...and for anyone else that's just starting out with this whole "testing process"...I SUGGEST YOU DEMAND THAT YOUR MRI'S BE DONE ON A "CLOSED UNIT" 3TESLA MACHINE!!!!! (That's NOT .3, but 3....NO period in front, indicating 3/10's of a whole!!!.....you need the WHOLE NUMBER 3). Hope it helps someone....as I had NO ONE to tell me the difference. I didn't find out until about a year after mine were done! Oh, and as someone else has suggested....demand that the "MS Protocol" be used.....with 3mm slices...and WITH contrast...in addition to without contrast!
Yup. My neuro scheduled a .7 tesla for me - for my spine. That's when I knew he was useless.
1.5 Tesla or better is MS protocol. 3T is pretty much the best you can get, and always worth it if you can find an imaging center with the equipment. And always with contrast, of course - I've had to call every time with my old neuro and confirm that it was with contrast.
I was reading this old post and had to comment. My last MRI was done in one of those mobile MRI's. It was done at our military hospital and once a week they have this Huge semi "portable MRI" come to scan patients. Anyways it seemed like a normal MRI machine (closed), but have since been worried about the quality of the machine. I called and asked Radiology what strength the MRI machine was and no one there knew! That isn't a good sign. I'm wondering if I should call the neuro office and see if they know about the strength. Also, I was saw the MRI order and it didn't say MS protocol, but it did say something about Demyleating Disease. Would this be the same thing?
Anyways just wanted to pipe in and see if anyone knew much about these "mobile MRI's?"
May I ask if you have the MRI with and without contrast on the same day? Do they take pics without and then administer the contrast? And if you didnt have contrast and have never had an MRI and it is your first is it therefore rendered useless?
Also would another way of people possibly getting around the insurance issue of not being allowed to only have an mri once every 6months or year might be if the MD ordered with contrast, if the first one was done without? Am I explaining this clear enough?
Skarey - there really is no way of knowing if the quality of images are worthy until you know the strength of the machine. My only experience is with a 1.5 closed and a 1.5 open bore. My opinion, the open bore quality does not match the 1.5 closed - but you reports should reflect the type of machine it was on. Also, my script for a brain MRI said "headache." But, the sequences ordered still showed lesions. Your report should reflect the sequencing too...
Missy - I don't think it's useless to get without contrast in the beginning if ordered for another reason. But, if MS is suspected contrast should be on the order to check for active demyelination. The contrast will light up those areas that are active at the time of the contrast. If there's not - nothing will change from the w/out contrast imaging. The health pages describes it best and it's very thorough - and called How MRIs show lesions. Hope you are able to check it out....
Yes I did thanks, My understanding of the pages was the first time is done without contrast and then with contrast. So what I asked was, are they done on the same day with and without contrast or does it depend on the clinical findings. Im not asking about the resolutions of the machines. I also asked if anyone knew for insurance purposes since usually only one MRI per every 6 months or a year is allowed usually i think, then if the md ordered without contrast like mine, would he then be able to go forward and order with contrast if clinical findings warranted it and maybe the insurance company would cover it. thats all.
I wasnt trying to repeat what was already in the health pages, and talked about ad nauseum. Sorry
Gotcha. No sorry necessary. Read it as if you had questions....
For me, it was both ways. When I presented to my MD with issues, she ordered a regular old MRI - no contrast.
Once there were lesions seen, off to the neuro I went, who ordered with and without contrast. Same day. Have heard a lot of people get w/out if ordered by an MD, and then the neuro repeats (both) with and w/out contrast. Man that's a lot of dough to get it redone huh? I'd venture to say that just like you say "clinically" the Dr. wants it - he or she will get it through (if you know what I mean). And, your Dr. is not in some "wait and see" mode.
Anywho, I'm sorry to misunderstand your original questions...
ok, i believe Ive got it, but just one more thing. You said when you went "off to your neuro he did with and without contrast". If your regular MD did without contrast why did your neuro repeat WITHOUT contrast, why not just do with contrast since you had already had a "plain old MRI" as you said. Had there been a significant time that had passed from when your md ordered it to when you went to the neuro? Is this making sense? Maybe im getting too tired. It just seems like they repeated the MRI without contrast twice.
Yes lots of dough. I would like to have my tspine redone on higher resolution machine. I would imagine the T-spine if your going to do it and c-spine for that matter if looking for lesions first time should be with contrast?
thanks - last question about contrast, I cant even take it myself :o) thanks
I think, but it's just a guess, it was repeated because:
1) He was suspicious of MS fromt he 1st MRI and wrote on his order MS (1st one said headache); and though the sequences were run to see lesions, at least now the dx on the script would tell the techs what to look out for and it's more of a guarantee of what to run; or/and
2) The neuro wanted it with and out contrast and there was a chance of active demyelinating to be seen, the only way to make an "exact" comparision would be for the with and w/out to be done all at the same time
Of course I'm just guessing, but I think this is why.
Thee do something similiar with an CSF and blood serum. i.e., At the time of the LP, they are suppose to check your blood for the very thing they are checking your spinal fluid for. Of course they can check either at a different time, but then it would not be an "exact" comparison done at the same time.
No worries on contrast questions - it's what we do here, and if I've gotten it wrong, someone will correct me....
Ok I think the key word there was exact time. thats really I guess the answer they didnt want any time lapse between with and without contrast. So they redid it w/wo regardless of the fact that you had already had one without contrast just done. Beside the issue of directily ordering in specifically looking for MS lesions and not migraines. And may perhaps the md just wanted a fresh start to the MRI and wanted to disregard prior one.
geez, sometims simple things that are so simple are so hard to get across in email like this, when if were were conversing in person or on the phone, you could have answered me in 30 seconds and I would have understood.:)
You know, I've been wondering lately why contrast is at all important when getting MRIs. I know it's part of the protocol, and that it shows where blood cells are migrating past the blood-brain barrier. But, the numbers I've seen thrown out are that active inflammation will only show up on contrast from 2 to 6 weeks.
So, it would seem there's a small chance that you're going to see enhancing lesions, anyway (if you have yearly MRIs, there would be about a 6/52, about 12% chance). I've had 4 MRIs over the past year, and not one has shown any enhancement. Some people argue that the lack of enhancing lesions indicates a progressive disease. Maybe, this is true. But people have told me they are still considered RRMS, and haven't seen enhancing lesion.
I guess if you are having a relapse, and the doctor orders an MRI at this time, then the contrast might be useful to see if active inflammation is going on.
From what I understand, it's relatively unusual for contrast to actually show anything, so from that perspective you're quite right.
If MRIs are ordered and carried out just after someone starts a flare, well and good. But in the real world, and especially for newbies where it's most important, the patient first sees a PCP, then is referred to a neuro. Actually seeing the neuro can take several months, a horrible situation for the patient. Then the MRI is scheduled. The patient may or may not still be having symptoms, but in any case the lesions are relatively old. So no enhancement under contrast.
The fact that nothing enhances, though, is not an indicator that the disease is progressive. That would be a totally erroneous conclusion. I don't know who argues that, but the facts say it's wrong. No conclusions can be drawn from lack of enhancement. If more lesions show up regardless, that's an indication of dissemination in time, one of the criteria.
Progressive MS is not the same as progressing MS. All MS is progressing, meaning that changes continue to take place at the cellular level so that the disease is always active, even if this is not apparent to the patient. But if someone has progressive MS, whatever form it might be, this means that there are no relapses and remissions, an entirely different kettle of fish.
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